41 research outputs found
Clinical significance of different effects of static and pulsed electromagnetic fields on human osteoclast cultures
No full textElectromagnetic fields are known to affect the bone metabolism by modifying some relevant physiologic cell parameters of cells, even though the underlying mechanisms are still unclear. The aim of our study was to evaluate the effect of both static magnetic fields (SMFs) of the same intensity of the one generated by spinal metal devices and pulsed electromagnetic fields (PEMFs) of the same intensity used for the management of nonunion on human osteoclasts cell culture. Primary osteoclast cells were isolated from primary human osteoclast precursors and were exposed to SMFs and to PEMFs. Morphology and tartrate-resistant acid phosphatase (TRAP) activity were evaluated in the osteoclast cultures after 7, 10, and 14 days of exposure. The SMF-exposed cells show a more differentiated phenotype and a significantly higher TRAP activity after 7 and 10 days of treatment with respect to a sham control. PEMF-exposed cells have a less-differentiated phenotype after 7 days of exposure compared with the relative sham control, while the TRAP activity shows no statistically significant differences between exposed and control cells at any observation time. Our results indicate that SMFs of the same intensity of the one generated around spinal devices can affect osteoclast differentiation and activity. Aseptic loosening around titanium implants might be due in part to an increased osteoclast activity and differentiation. PEMFs of the same intensity than the one used for the management of nonunions can affect osteoclasts phenotype after 7 days of exposure, while osteoclasts TRAP activity is not affected by this kind of electromagnetic fields
Clinical results and complication rates of lower limb lengthening in paediatric patients using the PRECICE 2 intramedullary magnetic nail: a multicentre study
No full textImplantable intramedullary nail lengthening devices (e.g., PRECICE 2 system) have been proposed as alternative method to external fixation for lower limb lengthening surgery. The aim of this study was to analyse our outcomes and complications using the PRECICE 2 (P2) nail system and review them in light of the existing literature. A retrospective multicentre study was conducted on patients <18 years, who were treated for limb lengthening using the P2 system. The inclusion criteria were a limb length discrepancy >= 30 mm and a follow-up >= 6 months after the end of treatment. A total of 26 (15 males) patients were included, average age was 14.7 +/- 2.3 years; 26 nails (21 femur, 5 tibia) were implanted. The average goal lengthening was 49.4 +/- 12.4 mm, while average achieved lengthening was 44.4 +/- 11.6 mm. Average distraction and consolidation indexes were 11.9 +/- 2.1 days/cm and 25.1 +/- 8.1 days/cm, respectively. Nail accuracy and reliability were 91.1% and 88.5%, respectively. A total of five problems (joint contractures), one obstacle (femur fracture) and three complications (hip joint subluxation, deep infection and nail running back) were encountered. The P2 nail system is a valid alternative to external fixator for limb lengthening in young patients with no significant angular or rotation deformities. Our study confirms a favourable complication rate and available evidence from literature suggests a lower complication rate than external fixator systems. Nevertheless, surgeons should keep a watchful eye on risk of joint subluxation and mechanical complications with intramedullary lengthening
Intramedullary Nailing for Lower Limb Polyostotic Fibrous Dysplasia in Children: A Long-term Follow-up Study
No full textbackground: In children, intramedullary nailing (IN) has been proposed as the best treatment when the femur and tibia are totally affected by fibrous dysplasia (FD). however, in younger children IN must be repeated to maintain stabilization of the affected skeletal segment during growth. we report the long-term results in a cohort of patients in whom more than two-thirds of cases had IN repeated during growth. methods: twenty-nine femurs and 14 tibias totally affected by FD were treated by IN in 21 patients with polyostotic FD and McCune-albright syndrome. thirteen patients with 35 femoral and tibial deformities had a painful limp whereas 8 presented fractures. the patients had their first IN at a mean age of 9.26±2.68 years (range: 4 to 14 y). IN was repeated during growth in the younger patients, and all the patients underwent a mean of 2.13 femoral and 1.50 tibial IN per limb. the last IN was performed at a mean age of 16.42±1.95 years (range: 11 to 19 y). titanium elastic nails and adult humeral nails were used in younger children, whereas adult femoral cervicodiaphyseal and interlocking tibial nails were used in older children and adolescents. at the latest follow-up, the patients were evaluated with a clinicoradiographic scale. All the data were statistically analyzed. results: the mean length of follow-up from the last IN was 6.47±3.10 years (range: 3 to 14 y), and the mean age of the patients at follow-up was 22.85±3.53 years (range: 14 to 29 y) when lower limbs were fully grown in all but 1 patient. satisfactory long-term results were obtained in about 81% of our patients, while complications occurred in 32.5% of the 43 cases. conclusion: lower limb IN-that was repeated in younger children during growth-provided satisfactory long-term results in most of our patients, with fracture and deformity prevention and pain control, regardless of the high rate of complications that mainly affected the femoral cases. missing scheduled follow-ups was the main predictor of a poor result. level of evidence: level IV-case series
Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications
No full textBackground. The modified Dunn procedure (MDP) has become popular during the last 16 years to treat severely displaced slipped capital femoral epiphysis (SCFE) while “in situ” pinning (ISP) has remained valid to treat mild to moderate SCFE, although the indication limit of the Southwick angle (SA) has not yet been established for either procedure. In this context, we reviewed two cohorts of patients with SCFE, one treated by ISP and the other by MDP. We also tried to better elucidate the etiopathogenesis of hip instability, a severe complication of MDP. Methods. Fifty-one consecutive patients with 62 hips affected by SCFE were treated by us from 2015 to 2019: 48 hips with a SA ≤ 40° had ISP while 14, with the SA > 40°, had MDP. The latter also had a CT scan to better investigate the SCFE morphology. Results were assessed using the Harris Hip Score. Results. The mean length of follow up of the two cohorts was 5.4 years (range: 3 to 8 years). Of the 35 hips operated by ISP with a full follow-up evaluation, 30 had an excellent or good result, 3, fair, and 2, poor. Of the 14 hips that underwent MDP, 11 had an excellent or good result, 1, fair, and 2, poor. A CT scan showed femoro-acetabular incongruency in two unstable hips following MDP. Conclusions. We performed ISP in chronic SCFE with the SA ≤ 40° and MDP in acute and chronic SCFE with the SA > 40°, with satisfactory results. In both acute-on-chronic and chronic long-lasting SCFE with severe displacement, planned for MDP, a CT scan should be carried out to evaluate possible femoro-acetabular incongruency that may cause hip instability
Enhanced recovery after surgery for adolescent idiopathic scoliosis: a revised systematic review and meta‐analysis
No full textAdolescent idiopathic scoliosis surgery (AIS) is often associated with high costs and significant recovery challenges. Enhanced recovery after surgery (ERAS) protocols aim to improve outcomes, reducing hospital stays and complications compared to traditional (TD) pathways. This study evaluates the impact of ERAS protocols on AIS treatment
Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: A Preliminary Report
No full textStem cells and tendinopathy: state of the art from the basic science to clinic application
No full textManagement of tendinopathies and tendon rupture is challenging.
In the last few decades, several emerging strategies including tissue engineering with mesenchymal stem cells have been proposed to enhance tendon healing.
They hold the promise to yield more successful outcomes for the management of patients with tendon pathology.
Current in vitro studies support the application of these cell-based therapies for the regeneration of tendon tissues. However, these cell-based strategies have been investigated only in pre-clinical studies and the role of stem cells needs to be confirmed. We performed a review of the literature to focus on actual knowledge and the future perspectives of stem cells for tendon regeneration and tendon engineerin
The Roman Bridge: a "double pulley – suture bridges" technique for rotator cuff repair
No full textAbstract Background With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. Methods We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. Conclusion This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone.</p
The Impact of Nitric Oxide Toxicity on the Evolution of the Glutathione Transferase Superfamily. A proposal for an evolutionary driving force.
No full textGlutathione transferases (GSTs) are protection enzymes capable of conjugating glutathione (GSH) to toxic compounds. During evolution an important catalytic cysteine residue involved in GSH activation was replaced by serine or, more recently, by tyrosine. The utility of these replacements represents an enigma because they yield no improvements in the affinity toward GSH or in its reactivity. Here we show that these changes better protect the cell from nitric oxide (NO) insults. In fact the dinitrosyl.diglutathionyl.iron complex (DNDGIC), which is formed spontaneously when NO enters the cell, is highly toxic when free in solution but completely harmless when bound to GSTs. By examining 42 different GSTs we discovered that only the more recently evolved Tyr-based GSTs display enough affinity for DNDGIC (K-D < 10(-9) M) to sequester the complex efficiently. Ser-based GSTs and Cys-based GSTs show affinities 10(2)-10(4) times lower, not sufficient for this purpose. The NO sensitivity of bacteria that express only Cys-based GSTs could be related to the low or null affinity of their GSTs for DNDGIC. GSTs with the highest affinity (Tyr-based GSTs) are also over-represented in the perinuclear region of mammalian cells, possibly for nucleus protection. On the basis of these results we propose that GST evolution in higher organisms could be linked to the defense against NO
